Provider Demographics
NPI:1821090820
Name:WATSON, ANGELICA (PT)
Entity Type:Individual
Prefix:
First Name:ANGELICA
Middle Name:
Last Name:WATSON
Suffix:
Gender:F
Credentials:PT
Other - Prefix:
Other - First Name:ANGELICA
Other - Middle Name:FIGUEROA
Other - Last Name:WATSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 29269
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87592-9269
Mailing Address - Country:US
Mailing Address - Phone:505-984-2032
Mailing Address - Fax:505-984-0738
Practice Address - Street 1:786A N SAINT FRANCIS DR
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87501-5100
Practice Address - Country:US
Practice Address - Phone:505-984-2032
Practice Address - Fax:505-984-0738
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-10
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM2790225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM2790OtherREG & LICENSING